removed by Liston and Aston Key) without difficulty in eight minutes, and with the loss of only five ounces of blood; the genital organs being preserved, and the patient having made a good recovery, notwithstanding attacks of erysipelas and various other unfavourable circumstances. Such an announcement could not fail to be in the highest degree gratifying; and it became all the more so when it was found the importance of Dr. O'Ferrall's plan of operation was only equalled by its extreme simplicity. Observing the great change produced in turgid varicose veins of the leg by placing the patient upon his back and elevating the limb, and the immediate arrest of hæmorrhage from such veins which ensues upon the adoption of this position, it occurred to Dr. O'Ferrall that, if the enlarged scrotum were held up, a similar withdrawal of the vital fluid would take place, particularly as regards the enlarged and tortuous veins which were the principal sources of hæmorrhage. The result completely justified the accuracy of this expectation,-the more so as the hemorrhage in these cases had been always observed to be principally of a venous character; the arterial hæmorrhage, in Aston Key's case, being estimated to be scarcely one-twentieth of the whole.

"Since the publication of Dr. O'Ferrall's plan, a complete change has occurred in these operations, which have since been performed in rather considerable number, and with an ease and success more or less resembling that experienced in his case. I now recur to the plan, because in two instances of operation published during the present year (in one of which an Asiatic was the subject) it appears to me that the able and successful operators, although adopting the method, omitted, in their reports of the cases, to make due acknowledgment to the author; contrasting, in this respect, with Mr. South, who, in his splendid work on Surgery, gives due prominence to Dr. O'Ferrall's plan.

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The application of this method is by no means limited to the removal of large scrotal tumours. On the contrary, it has been resorted to by Dr. O'Ferrall in cases of considerable innocent tumours of a vascular character; and in amputations he has obtained great advantages by loosely applying the tourniquet, elevating the limb, emptying it of venous blood by manipulation, and then tightening the tourniquet. The limb can thus be kept in a state of comparative anæmia while the amputation is being accomplished; and a loss of blood can be prevented, which, by deteriorating the general quality of the vital fluid, might have laid the foundation of subsequent disease. In fact, the value of a position by which the entrance of arterial blood into a limb will be retarded, and the exit of venous blood facilitated, is almost as useful in the performance of an operation as in the treatment of inflammation."

ART. 90.-On the Treatment of Nævus by Tartar Emetic.

By Dr. ZEISSL.

(Wien Wochenblatt, No. 9, 1862; Medical Times and Gazette, Oct. 25, 1862.)

Dr. Zeissl has found that nævi of medium size are best treated by the application of tartar emetic, which is both safe and effectual. It is true that this substance has long since been used for this purpose, and without much success; but in the employment of cauteries it is not of so much consequence which caustics we use, as how we use them. Neither a solution of tartar emetic nor the ointment will produce the desired effect. A plaster should be made of from sixteen to eighteen grains of tartar emetic and one drachm of diachylon, and a considerable portion of this should be spread all over and somewhat beyond the nævus by means of the back of a strong knife, and kept in situ by strips of gummed paper. On the fifth or sixth day the entire surface of the nævus begins to suppurate, a crust gradually forming, which falls off in about fourteen days, leaving a most surprisingly slight cicatrix. If the suppuration is very profuse, we may replace the plaster by simple oil-dressing; but when it is not profuse, the plaster may be left on until it falls off. When the plaster becomes accidentally removed, wholly or in part, it must be renewed. Dr. Zeissl has repeatedly employed this application, both in children and in adults, without pain being produced. He has, however, never as yet resorted to it for nævi of the mucous membrane of the lips.

ART. 91.—On the Importance of Tapping the Joints and Bursa Mucosa.

By Professor INZANI, of Parma.

(Omodel's Annali, Nov. 1862; Medico-Chirurgical Review, April, 1863.) The author begins by asserting the perfect harmlessness of puncturing a distended joint, even during the progress of acute inflammation. The fear of bad consequences following from the wound of the tendinous structures is a mere imagination of the ancients; nor does the air ever appear to make its entrance. The puncture may be made with a trocar or a lancet; the latter is preferable for superficial joints. The author has operated very frequently on the knee, several times on the elbow, occasionally on the carpus and ankle, and once only on the hip; no bad consequences ever followed. Pressure by means of a starched bandage should be made, and when the synovial sac refils, it should be again punctured before the distension has advanced too far. In this way a radical cure may be obtained. Examples are given in which large joints, principally the knee, were opened for effusions of blood, of serum in acute inflammation, of serum in chronic inflammation, and of pus—

usually with a successful result. But paracentesis should be avoided where the skin is much thinned and ulceration seems impending.

In the synovial bursæ, paracentesis has given equally good results. The examples which are given are those of effusion in the sheaths of tendons after accident (as the peronæi in sprains of the foot, the extensors of the thumb in falls on the hand), in which a puncture will give exit to synovial fluid mixed with blood, with much relief to the pain and abbreviation of the course of the disease.

The author believes that by these punctures chronic synovitis may often be arrested in cases which, treated by ordinary methods, would end in "white swelling," and that in dropsy of the joint the treatment by repeated puncture and pressure is as effectual and more safe than by injections.

ART. 92.- On the Influence of Hope as a Stimulant in Military Surgery.

By Dr. FRANK H. HAMILTON, Military Inspector U.S.A.

(American Medical Times, March 21, 1863.)

In an address to the graduating class of Bellevue Hospital Medical College, Dr. Hamilton says, and his words deserve to be remembered :

"Cold water and words of encouragement are excellent stimulants. Remember, gentlemen, that to the wounded and fainting soldier hope is a better cordial than brandy; and that you ought never to omit to offer words of encouragement, when it is in your power to do so.

ART. 93.-On the Wire Compress as a Substitute for the

Ligature.

By Mr. JOHN DIX, of Hull.

(Proceedings of the Royal Medico-Chirurgical Society, Jan. 13, 1863.) The wire compress the subject of this paper is a modification of the method of arresting hæmorrhage devised by Dr. Simpson of Edinburgh, and introduced by him about three years ago as a substitute for the ligature. The " acupressure,' as it is called, has been tested by but few surgeons of note; and in London, especially, it is almost unknown and ignored. Although probably a real improvement on the ligature, it undoubtedly labours under certain inherent disadvantages, most all of which (it is believed) are obviated by the use of a fine wire of iron or of silver, instead of the steel needles of Dr. Simpson.

This idea was first promulgated in a paper on Acupressure published in the Medical Times and Gazette of June 2nd, 1860; and

first put to the proof in a case of amputation of the finger, September, 1860. In this operation two arteries were secured by wire, which was removed on the third day. The case did well: there was no bleeding, and very slight suppuration.

The

In the next case-Chopart's amputation, performed April 26th, 1861-five wires were applied on as many arteries: four of these were removed in forty-eight hours, and the other on the fourth day. It was found that the wire was easily applied, as easily withdrawn, and entirely effectual for the purpose it was intended to serve— namely, the arrest of the bleeding from the cut vessels. patient, being the subject of constitutional syphilis, did badly. There was sloughing of the entire surface of the wound, and the flap was totally destroyed; notwithstanding which there was no hæmorrhage; but she died on the thirteenth day after the operation, of pyæmia.

In an amputation of the thigh, done September 21st, 1861, after Mr. Luke's method, there were seven bleeding arteries. Upon five of these the wire was used, and with the femoral artery the femoral vein was intentionally included; two very small branches were treated by torsion. This case did well. Seventy-two hours after the operation four of the " 'presse-artère" wires were withdrawn with perfect ease and without bleeding. The one on the femoral remained five days, when it, too, was removed without any difficulty and without a trace of blood. There was but little suppuration, and an excellent stump was the ultimate result.

These cases proved that this mode of securing arteries is practicable, efficient, safe, and manageable. It was also believed to possess a certain positive superiority over the ligature.

A ligature in a wound impedes union and induces suppuration. Cure, by primary adhesion, of a large wound-as, for instance, an amputation is an event of extreme rarity, and this because of the ligatures. A thread of silk is, in fact, a miniature seton, and the whole number required in an operation make up one of considerable size, and can scarcely fail to lead to the formation of pus. Again, the ligature of necessity excites ulceration of the artery upon which it is tied; it cannot in any other way be got rid of. This is another unhealthy process, antagonistic of repair. In applying a ligature, the end of the artery is drawn out from its sheath, by which its natural connexions are disturbed and its vasa vasorum broken up; its coats also are lacerated and bruised. The ligature remains for an indefinite time, long after it is useful or necessary, and it is not unfrequently pulled at by the dresser before it has become detached. Its knot, often deeply buried between the flaps, cannot be withdrawn without tearing through adhesions, or damaging the granulations. All these are serious obstacles to the healing process, both in the stump and the artery itself, and much protract the period of cure. Moreover, the following is an interesting and noteworthy formula: Pyæmia is the offspring of purulent secretion, of which the ligature is an efficient and probable cause. Bleeding arises solely from ulceration of an artery, of which again the primum mobile is the ligature.

,

From one and all of these objections to the ligature, the "wire compress" is almost or altogether free. Thus, in accordance with a well-known pathological law, it, being a metallic substance, is freely tolerated by the living body, and has little or no tendency to excite suppuration or irritation. Neither does it cause ulceration of the artery. This is positively affirmed from actual observation of its effect, as witnessed in the sloughing stump before alluded to. It is applied without interference with the natural relations and vital connexions of the vessel. It is removed at any time, according to the will and judgment of the surgeon, without disturbance to the reparative action going on in the artery and in the rest of the wound, without futile premature attempts, and almost without pain to the patient. It is not liable to loose its hold, or to become detached too soon, as not unfrequently happens to a ligature applied upon a brittle or sloughing artery. Twigs of nerve accidentally included in the embrace of the wire are not injured and excited as by the tight strangulation of the ligature; and, if thought advisable, the veins are easily and safely occluded, along with the arteries.

Although this has been spoken of merely as a modification of acupressure, yet it is believed to be a decided and important improvement on "Simpson's skewers," as the needles have been irreverently called, and which are fairly open to the following objections. When several of them are required, the stump resents, as it were, being thus pierced through and through in various directions. From the injury thus inflicted, and from the obstruction to the capillary circulation caused by the pressure of the unyielding steel, arise much tension, oedematous swelling, and great pain; the pain especially has been found a very serious evil. Again, their projecting ends, and the puckering they cause in the substance of the flaps, interfere very much with that accurate adjustment of the cut surfaces and edges which so greatly aids the chances of union by adhesion.

The wire is free from all these shortcomings. It is thus applied. Take a piece of surgical wire six or eight inches long, and thread each end thereof upon a straight needle. Seize the bleeding mouth of the artery with forceps, and pass one of the aforesaid needles close on each side of the artery just mentioned, about a line above the points of the forceps, directly down through the substance of the flaps, so that they emerge at the cuticular surface, about half an inch distant from each other. Draw them both through together till the curve of the wire compresses the artery on the face of the flap. Now get rid of the needles by clipping through the wire close above their eyes, and also detach the artery forceps. Place a piece of cork, cut for the occasion, upon the skin, between the points of exit of the wire, and over this twist the wire tighter and tighter until the bleeding is arrested. Lastly, cut off the superfluous wire. All which is done quicker than described. Two or more arteries lying near together may be embraced by one wire; and, as has been said, the veins may be included or excluded at will.

The wire should be either of silver, or, what is much cheaper and